Breastfeeding comes naturally to women but not everyone has the capacity to produce breast milk after birth. Even when the breast milk is released, some mothers produce so little that can barely cater for the nutritional demands of the infant. The option, therefore, lies in supplementary feeding in spite of the fact that for ages scientists have maintained that breast milk is the perfect food for newly-born babies. Until this day, limited or no production of breast milk continues to break the hearts of mothers.

Dr Jean Claude Nyirinkwaya, a gynecologist at La Croix du Sud Hospital in Remera, Kigali, explains that lack of breast milk production is more pronounced in first-time mothers because of anxiety, adding that absence of breast milk for the first few days after birth is common.

"After giving birth, it is not strange for a mother to spend two days without being able to produce breast milk. The challenge is that new mothers have no prior experience hence find more difficulty in releasing breast milk,” he says.

The other problem Nyirinkwaya highlights is that some babies may find it difficult to provide enough force to suckle the milk out of the mother’s breasts although this would eventually be overcome as they grow older.

"With such a problem, a glucose solution for energy provision for the first few days can be given to the infants, but mothers are advised to keep trying breastfeeding to initiate the release of milk from the breasts,” he adds.

Breast milk secretion

Dr Tharcise Ngambe, a pediatrician at King Faisal Hospital, Kigali, says normally, production of breast milk takes place in the mammary glands and begins as the body prepares for the arrival of the baby. By the sixth month of pregnancy, breasts become ready to produce milk.

He explains that secretion immediately starts after the placenta is delivered, a process, which causes a hormone known as prolactin to activate milk production, and by the third day after birth, a woman’s breasts become filled with milk. Suckling stimulates this reflex while another hormone oxytocin triggers the release of milk. A baby cry may also result into this reflex.

On a daily basis, the amount of breast milk produced varies and an Australian study found that one woman who produced 0.5 litres of milk a day had her baby gain well. However, the average lactating woman produces between 0.7 and 0.9 litres of milk every 24 hours.

Dr Ngambe says that mothers who fail to produce breast milk are influenced by both environmental and hormonal factors. "Any alterations in these two within the human body triggers a change in the amount of breast milk produced,” he explains.

On the other hand, low milk supply during breast-feeding could also result from waiting too long to start breast-feeding, not breast-feeding often enough, supplementing breast-feeding, an ineffective latch and use of certain medications. Sometimes previous breast surgery affects milk production, according to Mayo Clinic.

In other cases, premature birth, maternal obesity, pregnancy-induced high blood pressure and poorly controlled insulin-dependent diabetes are associated with limited or no milk production.

Also several studies have linked usage of birth control pills that contain estrogen to irregular breast milk production.

Dr Ngambe further explains that conditions which result into limited breast milk production tend to vary from individual to individual, but good nursing practices after birth improve overall milk production.

"Stress is a big contributor to the problem of lack or low breast milk production. When mothers give birth, it is only appropriate to have another individual looking after them but when this does not happen, it means they have to solely look after the baby. This also affects their milk production,” he explains.

Stimulating milk production

Dr Nyirinkwaya suggests that during the whole period after birth, good nutrition is very essential to provide all the nutrients mothers need for the body to produce enough breast milk.

"A regular diet balanced with vital nutrients such as vitamins, proteins, mineral salts and carbohydrates ensures that mothers have the necessary constituents for breast milk production,” emphasises Dr Nyirinkwaya.

Dr Rachna Pande, a specialist in internal medicine at Butaro Cancer Centre, advises that new mothers should empty their breasts as much as possible at whatever cost to stimulate production of more milk but babies should only be fed when they feel hungry.

"During the first two weeks of breast-feeding, even if it involves manually emptying after baby is satiated new mothers should empty their breasts. This stimulates milk production. It is better to feed the baby on demand rather than making a fixed timetable. This can be 10 to 12 times a day in the initial few weeks,” she says.

Pande adds that drinking adequate amounts of fluids and using warm towels to compress over the breast stimulates milk production.

"Also some herbs like garlic are said to stimulate breast milk production. If these measures fail it would be wise to consult and get tested for some underlying medical problem which can be treated,” adds Dr Pande.

The option of bottle-feeding

When some mothers fail to produce enough breast milk, they resort to bottle-feeding. However, Dr Ngambe warns that the choice of bottle should depend on the age and health status of the baby.

"Some bottles are designed for certain age groups. The tits are different, yet some babies require specific tits to suckle well. Other babies have medical conditions that require special bottles so these kits are different,” he says.

Research shows that breast milk production ensures that babies enjoy the benefits of ideal amount of nutrients and protection from several diseases through natural defense constituents in the milk. The World Health Organisation recommends exclusive breastfeeding starting within one hour after birth until a baby is six months old. Nutritious complementary foods should then be added while continuing to breastfeed for up to two years or beyond.

editorial@newtimes.co.rw

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BREAST-FEEDING BENEFITS FOR MOM AND BABY

* A healthier baby. "The incidences of pneumonia, colds and viruses are reduced among breastfed babies.

* Long-term protection. When you breastfeed your baby you reduce its risk of developing chronic conditions, such as type I diabetes, celiac disease and Crohn’s disease.

* Stronger bones. Women who breastfeed have a lower risk of postmenopausal osteoporosis. When a woman is pregnant and lactating, her body absorbs calcium much more efficiently. So while some bones, particularly those in the spine and hips, may be a bit less dense at weaning, six months later, they are more dense than before pregnancy.

* Lower SIDS risk. Breastfeeding lowers your baby’s risk of sudden infant death syndrome by about half.

* Fewer problems with weight. It’s more likely that neither of you will become obese if you breastfeed him.

* Better healing post-delivery. The oxytocin released when your baby nurses helps your uterus contract, reducing postdelivery blood loss. Plus, breastfeeding will help your uterus return to its normal size more quickly — at about six weeks postpartum, compared with 10 weeks if you don’t breastfeed.

* Less risk of cancer. Breastfeeding can decrease your baby’s risk of some childhood cancers. And you’ll have a lower risk of premenopausal breast cancer and ovarian cancer, an often deadly disease that’s on the rise.

* A custom-made supply. Formula isn’t able to change its constitution, but your breast milk morphs to meet your baby’s changing needs. Colostrum—the "premilk” that comes in after you deliver — is chock-full of antibodies to protect your newborn baby.

* More effective vaccines. Research shows that breastfed babies have a better antibody response to vaccines than formula-fed babies.

* A menstruation vacation. Breastfeeding your baby around the clock — no bottles or formula — will delay ovulation, which means delayed menstruation. Breastfeeding causes the release of prolactin, which keeps estrogen and progesterone at bay so ovulation isn’t triggered. When your prolactin levels drop, those two hormones can kick back in, which means ovulation — and, hence, menstruation — occurs.”

* A great way to learn about your baby. You have to read your baby’s ‘satiety cues’ a little better, because unlike with a bottle, you can’t see how much he’s eaten. You have to rely on your own instincts and your baby’s behavior to know when your baby is full.

* There’s nothing easier Simply pull up your shirt and nurse. Breast milk is always available and always at the right temperature.

* Better friendships. Breastfeeding helps cultivate relationships with other moms. Whether it’s talking about parenting styles, nighttime feedings or engorgement, nursing allows women to forge positive postpartum relationships. Women are supposed to be sitting together, nursing and taking care of babies.

Agencies

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THEIR SAY...

Raymond Awazi, a pediatrician at Sainte Famille Hospital, Kigali

It’s advisable that a mother should breastfeed exclusively for the first six months, but in case something hinders them from doing so, formula milk is a good alternative. However, this should be given to infants aged below three months without introducing food.

Claudatte Uwamahoro, a resident of Nyabugogo

In the past, if a mother died or the infant refused to breastfeed, we used to give such babies cow milk, but by mixing it with water if the child was below five months. I believe the same approach should be used by modern mothers since cow milk boosts the growth of children.

Christian Bahati, a general practitioner in Kigali

If the mother is unable to give her child formula milk, especially infant of one month or less, cow milk can work but only if it is mixed with water, sugar and soya to boost the development of baby’s brain.

Immaculate Kiza, a medical student at University of Rwanda

From four months and above, the child can be given whole milk. Although it is advisable that cow milk should be introduced to the child after one year, sometimes it becomes important to start the child on it early. Infants can be given soft foods such as porridge because of their weak digestive system.

Rosaline Uwamahoro, a medical student

If the infant stops breastfeeding, the best way to take care of them is to give them vegetable juice and fruits, especially those aged over three months. On the other hand, the mother or guardian should first seek advice from a medical professional on how to feed their infants in a healthy and nutritious way.

Compiled by Lydia Atieno.